PT03 Engage with the client in cognitive and behavioural therapy

Overview

This standard is about the process of creating a trusting, open and empathic environment essential for cognitive and behavioural therapy. It shows how the client is enabled to collaborate with the therapist and commence the psychological work. It includes giving the client information about practical arrangements relating to the therapy sessions and assurances relating to the therapist’s professional and ethical behaviour This standard describes therapeutic practice that has been shown to benefit adult clients engaged in cognitive and behavioural therapy for healthcare reasons, particularly depression and anxiety disorders. (See reference in the additional information section on page 3.) To apply this standard, practitioners also need to take account of the multiple problems and complex co-morbidities that individual clients may bring to therapy. Cognitive and behavioural therapy should be offered as part of an explicit and structured approach agreed within the treatment team and with the client. Users of this standard will need to ensure that they are receiving supervision and that their practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies. Version No 1

Knowledge and Understanding

You will need to know and understand:

Collaboration

1. conversational and questioning approaches that encourage client participation
2. collaborative techniques in cognitive and behavioural therapy


Working together in cognitive and behavioural therapy

3. verbal and non verbal behaviours
4. listening skills
5. effective and ineffective interpersonal behaviours
6. personal self awareness
7. how to engender trust
8. how to develop rapport
9. professional boundaries and codes of conduct
10. how to ‘read’ and interpret the client’s emotional reactions
11. possible sources of therapeutic impasse


Principles and practice of cognitive and behavioural therapy

12. cognitive and behavioural models of depression and anxiety disorders and their underlying mechanisms
13. psychological and social difficulties presented by clients with common psychological problems
14. the range of cognitive and behavioural therapy models and treatment plans that can be employed
15. the stages of human development throughout a life span and how they affect people and their needs
16. the impact of social relationships and environment on health and wellbeing
17. the changes in cognitive ability and the impact that age related transitions have on interpersonal networks
18. the effects and impact of prescribed medication, non-prescribed drugs and alcohol on the client’s health and wellbeing
19. the main goals of treatment for the client’s psychological problems
20. how to adapt your communication to the client’s individual needs

Performance Criteria

You must be able to do the following:

1. show levels of warmth, empathy, confidence and unconditional regard matched to client need
2. adopt a therapeutic style that accommodates  the client’s strengths, cultural background, life stage and cognitive ability
3. adapt your style to the effects on the client of any prescribed medication, non-prescribed drugs or alcohol
4. explicitly communicate the importance of collaborative discussion and the client’s ability to express their emotional reactions
5. utilise motivational approaches relevant to the client’s level of preparedness for therapy
6. adopt interpersonal behaviours that are likely to maintain engagement
7. avoid interpersonal behaviours that may put engagement at risk
8. provide clear information to the client about the arrangements for therapy
9. check with the client to see whether they feel engaged with the therapy
10. ensure, through feedback, that you and the client are understanding each other correctly
11. if the client shows signs of disengaging, adapt your approach to match or explore the client’s needs more closely

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard is derived from research reported in Roth A D and Pilling S (2007) The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. Department of Health/University College London. This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004). Dimension: HWB4 Enablement to address health and wellbeing needs